Healthcare Provider Details

I. General information

NPI: 1295087989
Provider Name (Legal Business Name): ANDREA SMALLS LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2012
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 N 7TH ST
WEST MONROE LA
71291-4107
US

IV. Provider business mailing address

1416 NATCHITOCHES ST
WEST MONROE LA
71292-3751
US

V. Phone/Fax

Practice location:
  • Phone: 318-737-7407
  • Fax: 318-737-7417
Mailing address:
  • Phone: 318-855-8773
  • Fax: 318-855-8779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number61503202
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2024010063
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3592
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: